| Background and Objective:Coronary atherosclerotic heart disease(CAHD),so called coronary heart disease(CHD)currently,was one of the major diseases that seriously threaten health and life safety of human being.With the improvement of the life quality in the several years,high-fat high-calorie diets,lacking of exercise,smoking and other unhealthy life styles were more and more common.At the same time,the incidence of CHD was rising continuously in our country,and trended to younger population.Intermediate coronary artery disease,purporting to stenosis of 40%-70%in cornory artery shown by coronary angiography(CAG),could be seen frequently through the progress of percutaneous coronary intervention(PCI).It was really important for an accurate assessment of intermediate lesions which had the risk of myocardial infarction and even sudden death,though it belonged an early stage of CHD.CAG,a gold criteria for the diagnose of CHD and the direction of PCI,only exhibited the lumen of the vessel where filled with contrast agents by two-dimensional image while angles,abnormal reference vessels caused by diffuse vascular lesions and eccentricity of the patch may also influence the accuracy of it.Also,most of the lesion vessels have positive remodeling and CAG can not exibite the lesion untlie the plaque occupied more than 50%of lumen cross section.Such disadvantages limit of CAG to evaluate the critical lesions precisely.Intravascular ultrasound(IVUS),an intravascular imaging technology,could not only display the stucture of artery,diameter of the lumen and vessel wall,cross sectional area,lesion length,but also identify the type and nature of plaque,and had qualitiative and quantitative analysis on it.Previous research showed that,for non left main coronary artery in which stenosis diameter>2.5 mm,the minimum narrow lumen area(minimal lumen area,MLA)<4 mm2 may lead to myocardial ischemia while delaying PCI on lesion may be safe for MLA?4 mm2.IVUS indirectly determined whether there was myocardial ischemia by evaluating the severity of coronary stenosis.Fractional Flow Reserve(FFR),referring to the ratio of the maximum blood flow to the myocardium and the one in the same area under normal conditions in the presence of a coronary artery stenosis,was used to directly administrate the function of the flow through coronary artery stenosis which considered to be the gold criteria to evaluate the pathophysiology status of intermediate coronary artery lesion.A number of studies had shown that the possibility of myocardial ischemia was small when FFR>0.8 in patients with stable coronary heart disease and it is safe and reliable to perform optimal medical treatment with delayed PCI.This sutdy divied into two parts.In the first part,we intended to involve 104 patients who diagnosed non-left main coronary artery critical lesions by CAG and divided them into IVUS group or FFR group follow-up for 1 years to observe the outcome of delayed PCI.In the second part,a total of 25 patients with intermediate coronary lesions(stenosis of 40%-70%)that confirmed by coronary angiography were performed with IVUS.When MLA?4mm2,we deferred the PCI treatment and performed optimal medical treatment(OMT).The patient were followed up for 12 month.The primary outcome was target vessel revascularization(TVR)and secondary outcome was major adverse cardiac events(MACEs).Result:In the first part,(1)There was no significant difference in general clinical information and coronary angiography between the two groups(P>0.05).No significant difference was found in the incidence of major cardiovascular adverse events between the 2 groups(P=0.716).In the second part,one patient with NSTEMI was performed revascularization because MI attacked again,and 2 patients with UA were treated with OMT but they were still rehospitalization because of angina occurred repeatedly.the incidence of TVR was 4.00%,so as 16.00%of MACE.Conclusion:Both IVUS and FFR examination for intermediate coronary disease are associated with favorable outcome,and IVUS can be used to guide the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome. |
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